Victorian plague alert as scurvy, scabies and rickets hit UK

A host of “forgotten” diseases that plagued Victorian Britain more than 150 years ago is making a shocking comeback in modern life, medics have revealed.

Cases of scurvy, rickets, scabies and measles are all on the rise due to poor diet, lifestyle and low uptake of essential vaccines.

The cost of living crisis has also resulted in an increase of malnutrition with almost 11,000 people admitted to hospital being undernourished, according to NHS figures.

There were 10,986 people diagnosed with malnutrition including 312 children in 2022-23 up for than fourfold in the last 15 years.

The increase is believed to be a contributory factor in the resurgence of diseases such as scurvy and rickets which are caused by vitamin deficiencies.

Sir Michael Marmot, director of the Institute of Health Equity at University College London, has called the rise in cases of scurvy, which famously afflicted sailors deprived of fresh fruit and vegetables in centuries past, as “horrendous.”

He said: “The idea we are starting to suffer the same diseases that in Victorian times people on long ocean voyages suffered because of the shortage of citrus fruits is simply horrendous.”

Professor Kamila Hawthorne, Chair of the Royal College of General Practitioners said: “It’s disheartening to see the emergence of diseases like rickets, measles and scurvy which should have been confined to the history books.

“Worryingly malnutrition is a major factor in conditions like scurvy. In the past few years we’ve seen fresh, healthier foods spike in price and become much less affordable for some of our most vulnerable patients. At the same time, ‘fast foods’ are cheap, filling and easy to access, but are low in nutritious content.

“Across the NHS, we have seen health inequalities worsen over the past ten years with the substantial reduction in funding for public services disproportionately affecting the UK’s more economically deprived communities. GPs are on the frontline of this public health crisis, caring for patients who are experiencing the health consequences of growing deprivation – a recent survey of our members found that 74% of GPs have seen an increase in the number of presentations linked to poverty over the past year.

“For diseases like measles and whooping cough, vaccination is vital. We once achieved the eradication of measles, but we can’t let our vaccination efforts slip or these diseases re-emerge. We would urge all parents to check their children’s vaccinations are up to date, and if they’re not, to make an appointment as soon as possible.

“Going forwards, it is vital that the government takes a prevention-based approach to health – also a clinical priority for the College – supporting people to live healthily, and protect their long-term health, which will not only improve their quality of life but ultimately alleviate pressures on the health service.”

Here we take a look at the diseases and afflictions once thought to have been eradicated by modern medicine that are making a comeback.

SCURVY

This disease is caused by vitamin C deficiency most commonly as a result of a poor diet lack fresh fruit and vegetables.

It was infamous ampong sailors of centuries past whose diet of bread, biscuit and preserved meat for weeks on end would bring on the disease.

The deficiency causes skin rashes, bleeding gums and toothloss, can cause old wounds to open up and prevent the healing of new ones.

NHS admissions have risen in recent years after consistently sitting below 100 per year before 2014.

But provisional figures for 2022-23 show 171 were admitted with a primary or secondary diagnosis.

Poor diet, malnutrition, drinking too much alcohol, obesity and smoking are among factors that can increase risk of scurvy.

Patients who have had bariatric surgery are also at increased risk due to dietary changes and the body having less ability to absorb nutrients.

Medics from Sir Charles Gairdner Hospital in Perth, Australia, cited a man in his early 50s who suddenly developed a painful rash of tiny redbrown pinpoints on his legs, had blood in his urine and low levels of healthy red cells.

Writing in the journal BMJ Case Reports, they said: “Further history revealed that the patient’s living circumstances were poor. He had financial constraints and therefore neglected his diet.

“His meals mostly comprised processed food, lacking in vegetables or fruit. Sometimes he would skip meals, which occurred more frequently in recent weeks.

“He had also stopped taking the vitamin and mineral supplements prescribed following gastric bypass surgery, as he was unable to afford them.”

Scurvy can be easily cured with vitamin C supplements and avoided by maintaining a balanced diet.

SCABIES

Transmitted by tiny mites that burrow and lay eggs under the skin, scabies is a disease associated with squalor and overcrowding.

Spread by close personal contact, it is so infectious that during the Victorian period, workhouses maintained separate “itch” wards so those infested with the mites could be segregated and treated before being allowed into the workhouse proper.

According to the Royal College of General Practitioners (RCGP), scabies cases are now running at three per 100,000 of the population in England, double the five-year seasonal average.

That amounts to approximately 2,000 cases of scabies a year. However, in the north, the worst affected region of England, GPs are seeing rates as high as six per 100,000.

The mites cause painfully itchy skin rashes and can only be treated with medication to kill the bugs and this must be done by treating whole family groups to make sure they are effectively eradicated.

RICKETS

In 2022, 423 patients were admitted to English hospitals with rickets, a disease caused by lack of sunlight and inadequate levels of vitamin D.

The disease causes weakening of the bones and is a particular danger to children causing pain and skeletal deformities.

It was rampant in the 1800s as a combination of children living in dark, slum conditions and smog blocking out the sun caused up to 60% of children living in London to develop vitamin D deficiencies.

The modern remedy is to get outdoors more during daylight hours and to take vitamin D supplements in the winter.

Dr Benjamin Jacobs, an expert on rickets at the Royal National Orthopaedic Hospital in Stanmore, Middlesex, says that in the 1980s it was unusual to see a case of rickets but today “I see at least three children with rickets each year; each case is a heartbreak,” he says.

“The NHS has provided free vitamin supplements for some children for almost 20 years, but the vitamins often don’t get to the children who need them most.

“It is shameful that the NHS has not made more progress preventing these severe diseases.”

MEASLES

The UK Health Security Agency reports cases of measles, for which there was no vaccine in Victorian times, are also increasing with 1,603 suspected cases in 2023, more than four times the number in 2021.

The increases is probably due to fears about vaccines and the difficulty of accessing jabs for households where both parents are in full-time work.

The highly contagious disease is caused by a virus that untreated can cause death or blindness.

Before vaccination programmes were introduced in 1963 the disease killed 2.6million people a year but the vaccines almost eradicated it.

In Birmingham earlier this year, the UKHSA declared a “national incident” as only 80% of children had received two doses of the measles, mumps and rubella (MMR) vaccine by their fourth birthday against a national target to readicate the disease of 95%.

In Hackney, east London, the figure is just 56.3% and a reduction in the number of health visitors nationally is adding to the problem.

Helen Bedford, professor of children’s health at University College London believes the shortage of health visitors is one of the factors driving the low uptake of the MMR jab and other vaccines.

She called for mobile vaccination centres and said: “It means those visits where mums got to ask questions about their baby’s health are not taking place or happening in the same way as in the past.”